title: A right-to-left shunt in children with arterial ischaemic stroke.
abstract: OBJECTIVE
  To compare the prevalence and grade of right-to-left shunt (RLS) in children with arterial ischaemic stroke (AIS) and in controls.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Tertiary paediatric referral centre. Patients 30 consecutive children with AIS.
  
  
  METHODS
  Contrast transcranial Doppler (cTCD) with Valsalva manoeuvre was performed in children with AIS and in controls.
  
  
  METHODS
  Detection and quantification of RLS.
  
  
  RESULTS
  Logistic regression analysis showed that RLS was significantly associated with AIS and prothrombotic disorders or with AIS of undetermined aetiology (OR 6.10; 95% CI 1.41 to 26.3; p=0.015). The prevalence of RLS was significantly higher in a group of children with AIS and prothrombotic disorders or with AIS of undetermined aetiology compared to controls (p<0.05). Significantly more microembolic signals (MES) were detected in a group of children with AIS and prothrombotic disorders or with AIS of undetermined aetiology than in controls (p<0.005).
  
  
  CONCLUSIONS
  Both the prevalence of RLS and number of detected MES were significantly higher in a group of children with AIS and prothrombotic disorders or with AIS of undetermined aetiology compared to controls. These findings suggest that paradoxical embolism may be an underestimated cause of AIS in children, particularly those with AIS and prothrombotic disorders or with AIS of undetermined aetiology.
authors.affiliation: Department of Paediatrics, University Medical Centre Ljubljana, Bohoričeva 20, Ljubljana, Slovenia. tomaz.podnar@mf.uni-lj.si
authors.forename: Mirjana Perkovic
authors.initials: MP
authors.lastname: Benedik
authors.forename: Marjan
authors.initials: M
authors.lastname: Zaletel
authors.forename: Nuska Pecaric
authors.initials: NP
authors.lastname: Meglic
authors.forename: Tomaz
authors.initials: T
authors.lastname: Podnar
mesh_terms: D000293:Adolescent; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000209:etiology*; D002648:Child; D019320:Embolism, Paradoxical / Q000150:complications; D004812:Epidemiologic Methods; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications*; D006801:Humans; D008297:Male; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology*; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods; D014636:Valsalva Maneuver